Sunday, August 18, 2013

Ibrutinib and R-CHOP

This is a little bit related to Follicular Lymphoma, but enough that it's probably worth mentioning.

An early-phase study of Ibrutinib combined with Rituxan and the CHOP chemotherapy had good results for patients with DLBCL. Only 15 patients in the study, but all of them had responses -- 10 complete and 5 partial. The study's primary aims were to determine optimal dosage for Ibrutinib and to determine side effects. The results were good enough to warrent larger trials with more patients.

I think this is important for Follicular Lymphoma patients for several reasons:

First, the results for those 15 patients came after an initial trial involving patients with otiher types of NHL, including Follicular Lymphoma. All of those patients had a response, which led to the second part, with just the DLBCL patients. So there is some (very small) indication that this combination could work well someday for Follicular patients.

This is not a surprise, of course. R-CHOP has long been a choice for FL patients, and Ibrutinib seems to be working for us, too. The question was whether or not they would interfere with each other. It seems like they don't.

That's the second (related) reason. There's a school of thought that traditional chemo isn't going away any time soon, and rather than looking for alternatives, we should be looking to enhance what we have, that we know is effective. This lends some support to that way of thinking. It's the same thinking that encourages RIT as a consolidation therapy -- getting Zevalin right after R-CHOP. You have three different ways of attacking the cancer cells: chemo + antibody + RIT.  This approach does something similar: chemo + antibody + kinase inhibitor. There's something to be said for this way of thinking. Until we have one treatment that can handle the job, ganging up might be the way to go.

Finally, as much as we hate to think about it, I'm always interested in treatments that might be an improvement in how we deal with DLBCL, since this is the lymphoma that most Follicular Lymphomas transform into, if and when it does transform. It might not be the exact same disease -- transformed DLBCL might be a little different than "original" DLBCL, which is why they have separate trials for them -- but it's good to know there's another avenue for future exploration by researchers.

As always, the warning: 15 patients is a really small number, and this is a really early trial. But it's got some stuff in there that make it worth keeping an eye on.

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